Challenges and solutions adopted by frontline health managers in the management of routine health services during the COVID-19 pandemic at the grassroots level in India: A qualitative quest.

Background: The public health emergency due to COVID-19 has placed an immense burden on the health care system. The strain for provision of health care services has also extended to routine services. The future impact of this decline in facility provision can be seen in morbidity and mortality indicators of the country. In a time when the country is working toward meeting the sustainable development goals (SDGs), COVID-19 has become a setback. Objective: This study tries to find the very challenges faced by frontline workers and the measures adopted to overcome the same. Materials and Methods: This was a mixed methods study conducted at various selected states across the country based on their vulnerability index. Data was collected via in-depth interviews among 120 frontline managers. Transcribed responses were coded. Framework analysis with preformed codes were done. Quantitative data are represented as frequencies and percentages. Results: Analysis showed increased work pressure, innovative approach adopted locally, and allaying fear by reinstating services helped as coping mechanisms to take care of routine health care services at the grassroots level. Conclusions: The conscious effort of all involved with the use of local solutions and innovations, along with intersectoral coordination and efficient use of resources paved the way for a good deliverance of health care to the society. The frontline managers minimized the damage by using available resources consciously and wisely.

Rabies encephalitis in a preschool child following postexposure prophylaxis.

We report a case of rabies encephalitis in a 4½-year-old male child with an exposure to a suspect rabid dog. The child developed rabies 25 days after receiving postexposure prophylaxis. Rabies immunoglobulin (RIG) is currently administered according to body weight. In high-risk exposures over the head and neck, local administration of RIG over and above the body weight depending on the site, size, and severity of exposure may help to prevent rabies death. There is a need for further studies to generate new evidence in this regard.

Indian classical music with incremental variation in tempo and octave promotes better anxiety reduction and controlled mind wandering-A randomised controlled EEG study.

Studies have reported the benefits of music-listening in stress-reduction using musical pieces of specific scale or 'Raaga'. But the influence of lower-level musical properties (like tempo, octave, timbre, etc.) lack research backing. Carnatic music concerts use incremental modulations in tempo and octave (e.g.: 'Ragam-Tanam-Pallavi') to elevate the mood of audiences. Therefore, the current study aimed to examine the anxiolytic effect of this musical property. A randomised controlled cross-over study with 21 male undergraduate medical students was followed. 11 participants listened to 'Varying music' (VM: instrumental music with incremental variations in tempo and octave) and 10 listened to 'Stable music' (SM: instrumental music without such variations), thrice daily for 6 days, both clips recorded in Raaga-Kaapi and silence being the control intervention. Electroencephalography (EEG) and Electrocardiography (for heart rate variability or HRV) were done on all 6 days. Beck's Anxiety inventory and State-trait anxiety scale were administered on Day-1 and Day-6. A significant anxiety score reduction was seen only in VM. VM showed marked decrease in lower frequency EEG power in bilateral temporo-parieto-occipital regions compared to silence, whereas SM showed increase in higher frequencies. Relatively, VM showed more midline power reduction (i.e., lower default mode network or DMN activity) and SM showed greater left-dominant alpha/beta asymmetry (i.e., greater right brain activation). During both music interventions HRV remained stable, unlike silence intervention. We speculate that, gradual transition between lower-slower and higher-faster music portions of VM induces a 'controlled-mind wandering' state involving balanced switching between heightened mind wandering ('attention to self') and reduced mind wandering ('attention to music') states, respectively. Therefore, music-selection has remarkable influence on stress-management and warrants further research.

A multicentric community survey on animal exposures among humans in India.

BACKGROUND: Rabies is a 100% fatal disease. There are inadequate data on animal exposures and rabies postexposure prophylaxis (PEP) from community-based field surveys in India. OBJECTIVES: : The main objective of the study is to estimate the incidence of animal exposures (bite, scratch, or lick) in the study population and to describe the rabies PEP among the cases. METHODS: A descriptive survey was conducted in seven states of India between July and November, 2017. In each state, multistage sampling methodology was followed for selection of district, taluka/tehsil, block, and clusters within the block. The primary sampling unit was a household (HH). A case was a patient with animal exposure (bite, scratch, or lick) in the last 1 year from the date of survey. The animal exposure was categorized based on the WHO guidelines (Category-I, Category-II, and Category-III). The patients with the history of multiple animal exposures any time during the survey period was considered as a single case. RESULTS: A total of 1012 HHs were surveyed covering a population of 4294. 3016 (70.2%) participants were from rural settings and 1278 (29.8%) were living in urban settings. 2181 (50.8%) participants were male and 2113 (49.2%) were female. The annual incidence of animal exposure was 1.26% (confidence interval [CI]: 0.93%-1.59%). The annual incidence in urban setting was 1.33% (0.70 - 1.96) and rural settings were 1.23% (CI: 0.84 - 1.62). Majority (68.5%) of the cases were from rural settings, 61.2% of the cases were in the age group of 15-60 years. Among the 43 cases who had received PEP, 21 had Category-II exposures, of whom 66.7% had completed vaccination with either five doses intramuscular or four doses intradermal route. Similarly, 22 had Category-III exposures and only 4 (18.2%) cases had received rabies immunoglobulin and completed rabies vaccination. Six ( 11.1%) cases did not receive PEP. There was no report of human rabies case. CONCLUSION: The incidence of animal exposure was 1.26%. Rabies PEP in the cases was not satisfactory.

Community awareness and risk of rabies associated with exposure to animals in India.

BACKGROUND: Rabies is a fatal but preventable disease. Around the world, awareness studies about rabies have been widely used to understand the disease and in its preventive measures. OBJECTIVES: The present study was conducted to assess the awareness of rabies as a disease, its transmission, and prevention among the general population and also to assess the perceived health risks associated with exposure to animals. METHODS: A cross-sectional study was undertaken across seven representative states in India between July and November 2017. Multistage sampling methodology was followed to select 1012 households as the primary sampling unit, and one adult responsible respondent from each household was interviewed as study participants. RESULTS: Six hundred and eleven (60.4%) participants had heard of rabies. Only 0.2% had extensive knowledge of rabies. Majority (440, 72.0%) of the participants considered rabies as a fatal disease; 77.3% opined that risk of rabies from dogs was high compared to 41.6% who believed that there was little or no risk of rabies from cats. Only 37 (3.7%) participants were aware about preexposure prophylaxis. CONCLUSION: The awareness on rabies and its prevention in the study population was not satisfactory.

An exploratory study on violence among the college students in Urban Bengaluru, Karnataka, India.

Violence often blights people's lives for decades, leading to drug addiction, depression, suicide, school dropout, unemployment, and recurrent relationship difficulties. This exploratory study was conducted among professional degree colleges in urban Bengaluru from January to March 2017; the objectives were to find the magnitude, forms, and substance use in violence. A total of 450 students were studied. One hundred and twenty-three (27.3%) students experienced some kind of violence in the past 1 year and 77 (62.6%) were males. Verbal abuse (65.0%), pushing around (23.6%), and slapping (18.7%) were common forms of violence observed. Substance use was significantly associated with violence.

A Comparative Study on Social Media Usage and Health Status among Students Studying in Pre-University Colleges of Urban Bengaluru.

INTRODUCTION: Social Media usage is a "global consumer phenomenon" with an exponential rise within the past few years. The use of social media websites is among the common activity for today's adolescents, they are sometimes overused/misused, which may lead to social media addiction. OBJECTIVES: The objective of this study was to assess and compare the prevalence of social media addiction between Government and Private Pre-University (PU) college study subjects, to assess the health problems related to social media usage among the study subjects, and to assess the various factors associated with social media addiction. MATERIALS AND METHODS: This cross-sectional study was conducted in Government and Private PU colleges situated in a selected ward of urban Bengaluru city through multistage sampling. A total of 1870 study subjects were recruited. A scale was developed to assess social media addiction. RESULTS: The prevalence of social media addiction was 36.9% among users, distributed equally among private and Government PUs. The most common health problem identified was strain on eyes (38.4%), anger (25.5%), and sleep disturbance (26.1%). Being a male, the habit of smoking, alcohol, and tobacco, consumption of junk food, having ringxiety and selfitis were found to be significant risk factors for social media addiction. CONCLUSION: Social media addiction was found in over one-thirds of subjects and majority had mild addiction.

An exploratory study on rabies exposure through contact tracing in a rural area near Bengaluru, Karnataka, India.

NEED FOR STUDY: Rabies is a neglected zoonotic disease. Given the low incidence, apart from the existing reporting syst, there is a need to look for other means of case detection strategies for rabies. Contact tracing is one such method to efficiently capture information. OBJECTIVES: To find out the rabid status of biting animal through contact tracing and to determine health seeking behavior of the bite victims. MATERIALS AND METHODS: An exploratory study using contact tracing was conducted during the first quarter of 2017 in villages coming under three Public Health Centers. The households of the bite victims were visited and details of rabies exposure obtained from the bite victim/ adult responsible respondent using a standardized questionnaire. RESULTS: A total of 69 dog/cat bite cases were identified. 69.5% of bites were by stray dogs. 97.1% bite victims had Category III bites. Only 4.5% bite victims had taken PEP. 70.1% of animal bite cases were administered ARV. Only 7.2% bite victims had exposure to probable rabid animals. All dog bite victims were alive after 3 months of follow up. CONCLUSION: Contact tracing was successful in case detection of probable rabid animal exposures and suitable for a period of one year.

Dengue serotype-specific seroprevalence among 5- to 10-year-old children in India: a community-based cross-sectional study.

BACKGROUND: Dengue surveillance data in India are limited and probably substantially underestimate the burden of disease. A community-based study was undertaken to assess the prevalence of dengue-specific immunoglobulin G (IgG) antibodies in children across India and to examine historical dengue exposure rates. Potential associations between socio-economic factors and dengue seroprevalence were also assessed (registered at ctri.nic.in: CTRI/2011/12/002243). METHODS: A convenience sample of 2609 healthy children aged 5-10 years was enrolled; these children were registered at or were living in the vicinity of eight centres located at six geographically distinct sites across India. Blood samples were drawn to test for the presence of dengue IgG antibodies using ELISA. Serotype-specific neutralizing antibody titres were measured in dengue IgG-positive children using dengue plaque reduction neutralization tests. Socio-demographic and household information was collected using a questionnaire. RESULTS: Overall, 2558/2609 children had viable samples with laboratory results for dengue IgG. Dengue IgG seroprevalence across all sites was 59.6% (95% confidence interval 57.7-61.5%): the lowest (23.2%) was in Kalyani, West Bengal, and the highest (80.1%) was in Mumbai. Seroprevalence increased with age. Multivariate analysis suggested associations with household water storage/supply and type of housing. Half of the subjects with positive IgG results presented a multitypic profile, indicating previous exposure to more than one serotype. CONCLUSIONS: The overall dengue seroprevalence suggests that dengue endemicity in India is comparable to that in highly endemic countries of Southeast Asia. Additional prospective studies are required to fully quantify the disease burden, in order to support evidence-based policies for dengue prevention and control in India.

Global positioning system & Google Earth in the investigation of an outbreak of cholera in a village of Bengaluru Urban district, Karnataka.

BACKGROUND & OBJECTIVES: The global positioning system (GPS) technology along with Google Earth is used to measure (spatial map) the accurate distribution of morbidity, mortality and planning of interventions in the community. We used this technology to find out its role in the investigation of a cholera outbreak, and also to identify the cause of the outbreak. METHODS: This study was conducted in a village near Bengaluru, Karnataka in June 2013 during a cholera outbreak. House-to-house survey was done to identify acute watery diarrhoea cases. A hand held GPS receiver was used to record north and east coordinates of the households of cases and these values were subsequently plotted on Google Earth map. Water samples were collected from suspected sources for microbiological analysis. RESULTS: A total of 27 cases of acute watery diarrhoea were reported. Fifty per cent of cases were in the age group of 14-44 yr and one death was reported. GPS technology and Google Earth described the accurate location of household of cases and spot map generated showed clustering of cases around the suspected water sources. The attack rate was 6.92 per cent and case fatality rate was 3.7 per cent. Water samples collected from suspected sources showed the presence of Vibrio cholera O1 Ogawa. INTERPRETATION & CONCLUSIONS: GPS technology and Google Earth were easy to use, helpful to accurately pinpoint the location of household of cases, construction of spot map and follow up of cases. Outbreak was found to be due to contamination of drinking water sources.

Prevalence of chronic obstructive pulmonary disease and its association with tobacco smoking and environmental tobacco smoke exposure among rural population.

A field survey was conducted for chronic obstructive pulmonary disease (COPD) epidemiology in the rural field practice area of Kempegowda Institute of Medical Sciences, Bangalore, India, which covers a population of 44,387 to find out the prevalence of COPD in adult subjects of 35 years and above using cluster sampling technique and to determine the association of tobacco smoking, environmental tobacco smoking (ETS) exposure and type of cooking fuel used with COPD. The overall prevalence of COPD was 4.36%. The prevalence among males and females were 5.32% and 3.41% respectively. The prevalence was found to be increasing with an increase in age. The tobacco smoke and exposure to ETS was significantly associated with higher odds of COPD with adjusted odds ratio 2.97 and 2.67 respectively. Thus, there was a significant association between tobacco smoking and ETS exposure with COPD.

Global Positioning System: a new tool for measurement of animal bites in a rural area near Bangalore, South India.

This exploratory study was conducted in villages near Bangalore, South India with the primary objective of spatial mapping animal bite cases using Global Positioning System (GPS) technology. GPS technology was useful as a new tool in accurate measurement of animal bite cases.

The Prevalence of the Beta Thalassemia Trait among the Pregnant Women who attended the ANC Clinic in a PHC, by using the NESTROF Test in Bangalore, Karnataka.

UNLABELLED: Contaxt: Every year in India 6000 to 8000 children are born with thalassaemia major. The birth of such a child produces considerable physical and economic strain on the affected child, its family and the community at large. Thus, the emphasis must shift from the treatment to the prevention of such births in the future. AIMS: To find out the prevalence of the Beta Thalassaemia trait among the pregnant women who attended the antenatal clinics in a Primary Health Centre, by using the NESTROF test; to describe the socio-demographic characteristics of the study subjects, to find out the pregnancies which were 'at risk' of delivering babies with Thalassaemia major and to find out the 'awareness' of the pregnant women regarding Thalassaemia. MATERIAL AND METHODS: This exploratory study was conducted in a PHC which was attached to the Department of Community Medicine of a medical college which was situated in Bangalore, India, for a period of 3 months. All the pregnant women who attended the antenatal clinic and the husbands of the NESTROF positive women were included in the study. The details regarding the sociodemographic characteristics of the women were collected on a structured proforma and the NESTROF test was performed. RESULTS: Out of the 210 pregnant women who were tested, 18 (8.5%) were thalassaemia carriers. 12 (66.6%) of them were between 20 - 25 years of age. 5 (27.7%) were born out of 2(nd) degree consanguineous marriages. 7 (38.8%) had a history of abortions, among which 6 (33.3%) were in the 1(st) trimesters of their pregnancies. Out of the 18 positive women, 9 (50%) had turned up with their husbands. All of the husbands were negative for the Thalassaemia carrier status. Thus, there was no pregnancy which was at a risk of delivering babies with thalassaemia major. None (100%) of the pregnant women were aware of the disease, thalassaemia. CONCLUSIONS: The prevalence of the Beta Thalassaemia trait among the pregnant women was 8.5%.

An exploratory study on socio economic status scales in a rural and urban setting.

BACKGROUND: There are many different scales to measure socioeconomic status (SES). The present study was conducted with the objective to compare the most commonly used SES in rural and urban setting. MATERIALS AND METHODS: This exploratory study was conducted in the rural and urban field practice area of a medical college situated in Bangalore for a period of 3 months between January and April 2010. STATISTICAL ANALYSIS USED: To measure the agreement between the scales spearman's rank correlations was applied. RESULTS: A total of 120 families were included in the study. Among the 60 families surveyed at rural setting, it was observed that, majority 40 (67%) belonged to high class when the Standard of Living Index (SLI) scale was applied. Among the 60 families surveyed at urban setting, majority 30 (50%) belonged to high class when the SLI scale was applied. CONCLUSIONS: The SLI scale gives a more accurate and realistic picture of the SES of the family and hence should be the scale recommended for classification of SES in urban and rural setting.

Prevalence of domestic accidents in the rural field practice area of a medical college in Bangalore, Karnataka.

Domestic accidents are worldwide health problems. A cross-sectional study was conducted in the rural field practice area of Kempegowda Institute of Medical Sciences, Bangalore. A total of 5419 individuals were selected from 30 clusters (villages) using cluster sampling technique. Of the 5419 study population, 50.9% (2748) were males and the rest were females. The prevalence of domestic accidents in the rural community was found to be 9.6% (522 individuals who had sustained domestic accidents), was found to be more in females compared with males, which was statistically significant with P-value =0.0077 (Z value =9.09). Falls 43% (225) was the most common type of domestic accidents. The most common place of occurrence of domestic accidents was 46% (243) kitchen, most frequent site of injures in domestic accidents was upper limbs.

Rabies in a blind patient: confusion after corneal transplantation.

Two blind persons received corneal transplants from a single donor who showed no signs of rabies before he died. One of the recipients, a young girl, died 16 days later of rabies and the other recipient survived. We discuss the possible mode of transmission of rabies to the first recipient and the management of the second recipient.

Global positioning system: a new tool to measure the distribution of anemia and nutritional status of children (5-10 years) in a rural area in south India.

UNLABELLED: Global positioning system (GPS) is a satellite-based navigation system that is of late being used in health care. OBJECTIVES: The aims of the study were to describe the geographical distribution and assess the prevalence of anemia and malnutrition in children aged 5-10 years with GPS. SUBJECTS AND METHODS: This exploratory study was conducted over a period of 2 months in the rural field practice area of a medical college situated in Bangalore during June-July 2012. Children aged 5-10 years were the study subjects. RESULTS: GPS was used for describing the geographical distribution of anemia and nutrition status on the Google earth map. The prevalence of anemia in the study subjects was 8.7%. The prevalence of underweight, stunting, thinness, and severe thinness among the study subjects was 52.8%, 28.5%, 23.5%, and 29.1%, respectively; however, overweight and obesity were observed only in 0.9% and 1.2% of the study subjects, respectively. CONCLUSION: GPS was easy to use and was able to demonstrate the actual distribution of morbidity at the household level in the rural area.

Prevalence of bronchial asthma and its association with smoking habits among adult population in rural area.

A cross-sectional study was conducted in the rural field practice area of Kempegowda Institute of Medical Sciences, Bangalore. A total of 3194 adult individuals (18-70 years) were selected from 30 villages (clusters) using a cluster-sampling technique. Individuals with symptoms suggestive of asthma were subjected for clinical examination for the diagnosis of asthma. Among the 3194 respondents, 1518 (47.5%) were males and 1676 (52.5%) were females. The prevalence of bronchial asthma was 2.88%. The prevalence of asthma was higher among those reporting a history of current smoking. Among current smokers, the number of cigarettes/bidis/hookah smoked daily did not differ (P > 0.05) between individuals without asthma and with asthma, whereas the mean number of years of smoking did differ (P < 0.001). There was significant association between tobacco smoking and bronchial asthma.

A clinico epidemiological study of tetanus cases admitted to epidemic disease hospital, Bangalore.

A descriptive study was conducted among tetanus cases admitted to epidemic disease hospital (EDH), Bangalore from October 2006 to March 2007 to describe the socio demographic characteristics of tetanus cases, the clinical presentation and the treatment given to tetanus cases. A total of 80 cases were admitted during this period. Out of the 80 tetanus cases, 71% were from rural area, 55% unimmunized, 47.5% were agricultural workers. A total of 25 (31.25%) deaths were observed during the study period. No case was administered anti tetanus serum outside the epidemic disease hospital.

Usefulness of direct recording scale as a new tool for growth monitoring.

The present study was conducted to assess the acceptability and usefulness of Direct Recording Scale (DRS) as a tool for growth monitoring of under five children in a rural community area of Karnataka among 46 mothers. A total of 40 children were followed up for one year, 50% mothers preferred having DRS at home, 87.5% mothers said DRS, helps in detecting undernutrition, 48% mothers needed no help in using DRS, 50% mothers were regular in weight recording, 87.5% mothers wanted the weight recording done once in three months. All families had accepted DRS as a tool for growth monitoring.